Comparing the Traditional Versus Conservative Endodontic Access Cavities Design of the Maxillary First Molar: Using Cone-Beam Computed Tomography

BACKGROUND: This study aimed to compare the size and location of the traditional and conservative endodontic access cavities of the right maxillary first molar teeth, projected on the occlusal surface using cone-beam computed tomography (CBCT), to obtain an ideal access cavity. MATERIAL/METHODS: Five hundred CBCT images of the right maxillary first molars, including 198 males and 302 females, were retrospectively evaluated using KaVo eXam Vision software. First, a rectangular coordinate system was established. The coordinates of 4 pulp horns and 3 root canal orifices, which projected on the occlusal surface, were marked on it. Two different access cavities were then created by connecting these points: (1) traditional endodontic access cavity (TEC) required removal of the entire roof of the pulp chamber to establish a straight-line access to the root canal system; (2) conservative endodontic access cavity (CEC) was formed by connecting the projection of each root canal orifice on the occlusal. Data were analyzed using Kruskal-Wallis and Pearson’s correlation tests at a 5% significance level. RESULTS: The area of TEC was approximately 9.61 mm(2) for males and 8.91 mm(2) for females. The area of CEC was approximately 3.4 mm(2) for males and 3.16 mm(2) for females. The projections of all pulp horns and root canal orifices were in or near the central area of nine-rectangle-grid. CONCLUSIONS: Compared with the traditional access cavity, creating a conservative access cavity was less invasive. Meanwhile, the access cavity should be limited to the central or near the central area of nine-rectangle-grid.